Scoping Review of Adolescent Autonomy and Responsibility for Managing Chronic Physical Conditions

BACKGROUND: Adolescents' autonomy is a key developmental milestone. Adolescents rely on active support from parents, nurses, and peers as they transition toward self-managing their chronic health conditions. Gaining insight into how adolescents perceive and practice autonomy is essential for supporting the gradual transfer of disease self-management responsibilities. OBJECTIVES: To map and synthesize evidence on adolescents' perceived autonomy and responsibility for self-management of their chronic conditions, including decision-making, goal setting, and actions. METHODS: This review followed the Joanna Briggs Institute methodology and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Searches were conducted in CINAHL, APA PsycARTICLES, PubMed, Nursing and Allied Health, Scopus, and Embase without publication date limits, yielding studies published between 2002 and 2024. A total of 4,738 studies were imported into Covidence for screening. Results were analyzed using inductive content analysis. RESULTS: The review included 30 articles. Four main categories were identified related to how adolescents perceive autonomy and progressively assume, exercise, and sustain responsibility for their daily care and self-management: (a) navigating responsibility transfer and regression; (b) communication and support for readiness; (c) emotional turmoil and identity adaptation; and (d) emerging autonomy in action. DISCUSSION: Acquiring self-management skills introduces a growing complexity of effectively monitoring symptoms, adhering to treatments and medication regimens, acquiring dexterity for interventions, and action planning. Nurses play a vital role in assessing adolescents' readiness for autonomy based on developmental maturity and health literacy rather than age alone, while actively involving them in care decisions to foster confidence and a gradual assumption of self-management responsibilities.